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Breast cancer and "sex" are not words that seem to go together. Yet, perhaps they should, given the profound way in which a diagnosis of breast cancer and treatment can alter a woman’s sex life and her feelings about being sexually intimate.

On average, the frequency of sex drops from once a week to once or twice a month after a diagnosis of breast cancer and may never pick back up after treatment, says Barbara Andersen, professor in the department of psychology and the department of obstetrics and gynecology at Ohio State University. But couples can and should stay intimate with hugs, kisses, and shared activities, she says.

Breast Cancer and Sexuality: What's the Connection?

The realities of breast cancer diagnosis and treatment are obstacles to being sexual, according to Andersen. The emotional shock followed by a major surgery and grueling radiation and chemotherapy treatments are enough to take away anyone’s sexual desire.

Cancer patients are not feeling very sexual. They are suffering malaise, nausea, vomiting, [and] hair loss. They don’t feel very attractive," says Andersen. The maintenance drugs that many women have to take to keep breast cancer from recurring can also put a damper on a couple’s sex life.

What's more, chemotherapy can push a woman into menopause. "You put all of that into a package — in addition to undergoing a major life stressor, cancer — it's not surprising that sexual activity goes through this period of change," says Anderson. "Certainly for many people it just stays at this lower baseline."

Breast-cancer survivor Marcia Scanlin, a resident of Columbus, Ohio, was blindsided by the effects of one of her maintenance medications. She was on a five-year course of letroxole (Femara) to prevent the return of her cancer when she experienced vaginal dryness, making sex uncomfortable for the first time.

"That created a feeling in me of: 'I'm scared, I don't want to, it's painful — this is not fun and enjoyable like it used to be," says Scanlin. With the support of her doctors, she began taking a prescription medication to counter the vaginal dryness. But Scanlin, who considers herself a well-informed patient, says there are always unexpected side effects.

Emotional Support Is Key

An understanding and affectionate spouse can make a huge difference for a woman as she goes through treatment. Scanlin says her husband "really came to the fore during our battle" against breast cancer. She and her husband see the same family doctor, and her husband sought his advice many times during Scanlin's treatment.

"The doctors are very good at telling you [that] you can have a sexual relationship, that it won’t harm anything," says Scanlin, who recalls periods of time where she felt she was shortchanging her husband. "I would say — just because there were lots of days I felt like crap — that [sex] was mostly a 'hug, kiss, snuggle' at that time of my life."

Scanlin says she and her husband were not shy about discussing sex with her doctors. That, she notes, probably helped the couple get through the rough spots. For women and their husbands who are embarrassed to discuss issues of intimacy, Scanlin recommends:

Talking to a female nurse if the woman's doctors are male

Having her spouse discuss his feelings and concerns privately with his wife's oncologist

Reading books about sex during and after breast cancer

Timing is important, too, says Andersen. If you want to be sexually intimate, remember that breast-cancer patients suffer from intense fatigue, sometimes for up to a year after treatment ends. Try for an afternoon rendezvous instead of a late-night date!

With some patience and loving support, it is possible for women and their partners to enjoy sex after breast cancer.